A non profit organization dedicated to promoting the welfare of animals
through leadership, education, adoption and rescue.

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PRE-ADOPTION QUESTIONAIRE - DOG/PUPPY

Title
   Mr. Mrs. Ms.
Name
Street
  
City
  
County
  
State
  
Zip
  
Home Phone
  
Work Phone
 
Mailing Address (if different)
 
Email Address (optional)
 
Employer
Occupation
  
Spouse/Partner Title Mr. Mrs. Ms.
Spouse/Partner Name
 
Spouse/Partner Employer
 
Spouse/Partner Work Phone
 
     
How did you hear about
Another Chance Animal Wlefare League?
 
Newspaper Friend
Radio internet
TV Offsite Event
Yellow Pages Other
Another Chance Animal Welfare League is committed to providing continuing consultations to any families that adopt from us and to build lifelong relationships between people and their pets.
1. Briefly describe why you would like to adopt a dog/puppy.  
HOUSEHOLD:    
2. Do you live in:  
House Mobile Home
Townhouse Apartment Complex
Condo Name
3. Does your lease allow pets?   Yes No
Landlord Name:
Landlord Phone Number:
4. Do you need to contact your landlord before we do to verify this information?   Yes No
5. Do You;   Rent Own
How long have you lived at this address?
6.Please list the names of all household members. Include ages for household members under 18.  
7.For whom are you adopting this pet?  
Self Gift
Children Other Pet
Family Other
8. Who will be primarily responsible for the care and supervision of the animal?  
9. Will this dog be in the presence of children frequently?   Yes No
If yes, what ages?
10. Do any household members have known allergies to dogs?   Yes No
LONG TERM PET CARE:    
11. What will happen to this dog if you move?  
12. Are you prepared to accept the cost of a dog in the home?   Yes No Don't Know
13. Do you have a veterinarian for your pet(s)?   Yes No N/A
Clinic Name:
14. Approximate date of last vaccinations for current pet(s)?  
ANIMAL SELECTION/ BEHAVIORS
15. As an adult, have you owned a dog?   Yes No
If yes, what breed?
16. How active a dog do you want?  
Agility
Running Companion
Dog Park/Fetch
Walking Companion
Lounging
17.How many hours each day will your household be without people?  
18. Please list the pets that you have had in the past five years (both current and those you no longer own): Breed/Type; Age; Sex; Spayed/ Neutered; How long owned?; What happened to him/her?  
19. Puppies:    
Do you want to house the puppy indoors?   Yes No
if yes, when?
Do you want to house the puppy outdoors?   Yes No
If yes, when?
20. Dogs:    
Do you want to house the dog indoors?   Yes No
If yes, when?
Do you want to house the dog outdoors?   Yes No
If yes, when?
20. a) Where will this animal sleep?  
21. How will you keep this dog confined to your property?  
22. When did you last housetrain a dog?  
What method did you use?  
23.Do you plan on attending dog training classes with your new dog?   Yes No Maybe
24. For what potential problems do you feel unprepared? Please check all that apply.  
Biting
House soiling
Not good with other animals
Not good with children
Excessive chewing
Excessive grooming needs
Excessive activity level
Medical issues
Confinement issues
Other
25. Are your own dogs licensed with the appropriate agency?   Yes No
Be advised that if you live in Shasta County, we will be submitting your information regarding this canine adoption to them for licensing records.
 
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